This is a template you can edit before printing. Your GP makes the clinical decision about your referral — this is not medical advice.
18 October 2026
[Your full name]
[Your address line 1]
[Your address line 2]
[Your postcode]
NHS number: [Your NHS number, if known]
[Your GP's name]
[Your GP surgery]
Re: Request for referral to SpaMedica Portsmouth for Ophthalmology Service under my NHS Right to Choose
Dear Dr [GP's name],
I am writing to formally request that my forthcoming first outpatient referral for Ophthalmology Service be made to SpaMedica Portsmouth (Portsmouth, PO6 4PR) under my NHS Right to Choose, as set out in the NHS Constitution and the Choice Framework.
The NHS Choice Framework says that, at the point of referral for consultant-led treatment, I can choose which provider I am referred to, from those that have an NHS contract to provide the service I need. I have chosen SpaMedica Portsmouth after researching publicly available NHS data on waiting times at HospitalWaits.co.uk, which shows SpaMedica Portsmouth provides Ophthalmology Service services.
I understand that you decide whether a referral is clinically appropriate, and that the right has some exceptions. If you think this referral would not be clinically appropriate, or that an exception applies, I would be grateful if you could explain why during my appointment so we can discuss alternatives.
For your reference, the NHS Choice Framework is published by the Department of Health and Social Care at www.gov.uk/government/publications/the-nhs-choice-framework, NHS England's patient choice guidance is at www.england.nhs.uk/long-read/patient-choice-guidance/, and my choices are also described on the NHS website at www.nhs.uk/using-the-nhs/about-the-nhs/your-choices-in-the-nhs/.
Please confirm in writing (or via the NHS App message system) once the referral has been made.
Yours sincerely,